NPIMap

Organization Active NPI

Fremont Health

  • Registered Dietitian
  • Fremont, NE
National Provider Identifier
1104075407
Registry record updated Jan 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Legal business name
FREMONT HEALTH
Practice address
450 E 23Rd St
Fremont, NE 68025-2303
Phone
(402) 721-1610
Fax
(402) 727-3433
NPI assigned
Sep 11, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Patrick M Booth
Title
President/Ceo
Phone
(402) 721-1610

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133V00000X Primary

Addresses

Primary practice location

450 E 23Rd St
Fremont, NE 68025-2303

Mailing address

450 E 23Rd St
Fremont, NE 68025-2303
Phone (402) 721-1610

Other identifiers 1

IdentifierTypeStateIssuer
81068OtherNEBLUE CROSS BLUE SHIELD OF NEBRASKA

Other names 1

  • Fremont Health Medical Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Memorial Hosp of Dodgec11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1221091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422144000000",
    "number": "1104075407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 E 23RD ST",
            "city": "FREMONT",
            "state": "NE",
            "postal_code": "680252303",
            "telephone_number": "402-721-1610",
            "fax_number": "402-727-3433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 E 23RD ST",
            "city": "FREMONT",
            "state": "NE",
            "postal_code": "680252303",
            "telephone_number": "402-721-1610",
            "fax_number": "402-727-3433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREMONT HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-11",
        "last_updated": "2015-01-25",
        "status": "A",
        "authorized_official_last_name": "BOOTH",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "402-721-1610",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF NEBRASKA",
            "identifier": "81068",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fremont Health Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fremont, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.